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b <br /> Mor UUNd WELL <br /> - <br /> 1`Y�71 <br /> 1. <br /> CONS' UC7'ICN <br /> Dace: y <br /> c f Total Depth (to} S <br /> p-e_.:se address: ee. L.ez (from) <br /> Sc <br /> �).FilLe:Pack•N {from} .. '70 {, <br /> Well No.: ge-*ttoruLe CL—OM) (to) o' <br /> Grout (from) <br /> ;i e 4 <br /> '1nsPec:o'r Drs�lin4 <br /> ' , g LYP ger 0L- zr t^.r�zi• circle one) <br /> Per-== No. <br /> Completion Stove pipe! a box C <br /> Dr .Compare <br /> illing Y <br /> he; h= <br /> �. <br /> -l - �C'YrvF�O[lNt7 Cl�l'r�"!�CX_4 x:• <br /> C-eolog;.st .; �.e;� .; � x� » -- tr+?L.ri;CM - <br /> Grcuad Si-fal <br /> C <br /> S?St ocR_b4T n7-0. Qr(lai : <br /> _ 4 0 F > `•. <br /> !in <br /> � <br /> Distance to $ewe-r .i..e �� 3 ;f.. <br /> Darnest:c well on site - C Y� <br /> It yes, location and distance ', <br /> R = 19 C 4• <br /> T. <br /> Shy[?. <br /> Holdira T e Dear:relk <br /> - <br /> Y[e*hod � C <br /> Sceening Method I r <br /> T:ac'.cing Sheet - y n) <br /> �.� ► <br /> SPOILS r Y <br /> Storage Method <br /> nta.-aizsazion Noted - y n 11���6D Ve l� ,, Casing Lype�t^ <br /> fC <br /> Stora_e Location„ � _ .r ala fL Steen <br /> Io - PVc Z slat Size oZ <br /> "`�.. gags <br /> tsucke1 be ton1Le <br /> gags saad/gavel 9 z- <br /> Depth to water 55 `• y _ F'ilte-•Pack typesize 3 <br /> M, 'M Rados -f-.. j <br /> Installation Me.:od Discssed with.geolog-sv - , n)~' <br /> Quand:y tnstalled "' T -Type of method <br /> � ..w - .. . -x.' i�. — .... � --ars r t .w.• ..r . ,-� . .!. <br /> iE <br />